Individual
DR. WILLIAM BRYAN GIBBONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, FNP-C, ACNP-BC
Contact information
Practice address
1434 CENTRAL AVE E, WIGGINS, MS 39577-9602
(228) 436-1191
Mailing address
6699 OLD FORT BAYOU RD, OCEAN SPRINGS, MS 39564-7987
(228) 872-4349
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
R861831
MS
363LF0000X
Family Nurse Practitioner
Primary
R861831
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01030384
—
MS
01
—
512I500588
MEDICARE PTAN
MS
Enumeration date
04/15/2008
Last updated
12/23/2019
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